Chapter 1 Copyright © 2018 Wolters Kluwer · All Rights Reserved Chapter 1 Decision Making, Problem Solving, Critical Thinking, and Clinical Reasoning: Requisites for Successful Leadership and Management Copyright © 2018 Wolters Kluwer · All Rights Reserved Decision Making, Problem Solving, Critical Thinking, and Clinical Reasoning • Decision making: complex, cognitive process of choosing a particular course of action; the thought process of selecting a logical choice from available options • Problem solving: part of decision making; systematic process focusing on analyzing a difficult situation Copyright © 2018 Wolters Kluwer · All Rights Reserved Decision Making, Problem Solving, Critical Thinking, and Clinical Reasoning—(cont.) • Critical thinking or reflective thinking: the mental process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and evaluating information to reach an answer or conclusion Copyright © 2018 Wolters Kluwer · All Rights Reserved Characteristics of a Critical Thinker • Insight • Intuition • Empathy • Willingness to take action Copyright © 2018 Wolters Kluwer · All Rights Reserved Clinical Reasoning • Integrating and applying different types of knowledge to weigh evidence, critically think about arguments, and reflect on the process used to arrive at diagnosis • Collaborative and reflective process that involves content-specific knowledge, engagement of the patient and family in understanding the clinical problem, and incorporation of critical contextual factors • Leads to deliberative decision making and sound clinical judgement Copyright © 2018 Wolters Kluwer · All Rights Reserved Vicarious Learning to Enhance Decision-Making Skills • Case studies: provide stories that impart learning • Simulations: provide opportunities for learning with no risk to patients or organizational performance • Problem-based learning (PBL): provides opportunities for learners to address and learn from authentic problems vicariously Copyright © 2018 Wolters Kluwer · All Rights Reserved Experiential Learning • Provides mock life experiences to learn from • Allows learners to apply leadership and management theory • Promotes whole-brain thinking and improved problem-solving skills Copyright © 2018 Wolters Kluwer · All Rights Reserved Successful Decision Makers • Self-aware • Courageous • Sensitive • Energetic • Creative Copyright © 2018 Wolters Kluwer · All Rights Reserved Question Which is a characteristic of a successful decision maker? A. Impulsiveness B. Courage C. Decisiveness D. Whimsy Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer B. Courage Rationale: A successful decision maker should be willing to take risks. Copyright © 2018 Wolters Kluwer · All Rights Reserved Marquis-Huston Critical Thinking Teaching Model Copyright © 2018 Wolters Kluwer · All Rights Reserved Problem-Solving versus Decision-Making Models The Traditional Problem- Solving Process • Identify the problem. • Gather data to identify the causes and consequences of the problem. • Explore alternative solutions. • Evaluate each alternative • Select appropriate solution • Implement solution • Evaluate results. Managerial DecisionMaking Model • Determine the decision and the desired outcome (set objectives). • Research and identify options. • Compare and contrast these options and their consequences. • Make a decision. • Implement an action plan. • Evaluate results. Copyright © 2018 Wolters Kluwer · All Rights Reserved Critical Elements in Problem Solving and Decision Making • State a clear objective. • Gather data carefully. • Take the time necessary. • Use an evidence-based approach. • Generate many alternatives. • Think logically. • Choose and act decisively. Copyright © 2018 Wolters Kluwer · All Rights Reserved Nursing Process: A Problem-Solving and Decision-Making Model • Assess. • Diagnose. • Plan. • Implement. • Evaluate. Copyright © 2018 Wolters Kluwer · All Rights Reserved Feedback Mechanism of the Nursing Process Copyright © 2018 Wolters Kluwer · All Rights Reserved Question Which is NOT a factor in solving a problem successfully? A. Using an evidencebased approach B. Doing all work independently C. Stating a clear objective D. Watching for faulty logic Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer B. Doing all work independently Rationale: It is important to use group process in some way to increase solutions. Copyright © 2018 Wolters Kluwer · All Rights Reserved Questions Asked in Data Gathering • What is the setting? • What is the problem? • Where is it a problem? • When is it a problem? • Who is affected by the problem? • What is happening? • Why is it happening? What are the causes of the problem? Can I prioritize the causes? • What are the basic underlying issues? Areas of conflict? • What are the consequences of the problem? Which of these are most serious? Copyright © 2018 Wolters Kluwer · All Rights Reserved Questions Asked in Analyzing Solutions • What factors can you influence? How can you accentuate the positive factors and minimize the negative factors? • What are the financial, political, time, and resource implications of each possible solution? • What are the weighting factors? • What is the best solution? • What are the means of evaluation? • What are the consequences of each alternative? Copyright © 2018 Wolters Kluwer · All Rights Reserved Question What is the first step in managerial decision-making model? A. Identify the problem. B. Evaluate alternatives. C. Gather data. D. Set objectives. Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer D. Set objectives. Rationale: Although the traditional model begins with identifying the problem, in managerial decisionmaking model, one approaches the issue by first deciding on the objectives. Copyright © 2018 Wolters Kluwer · All Rights Reserved Strategies for New Nurses to Promote Evidence-Based Practice • Keep abreast of the evidence. • Use multiple sources of evidence. • Use evidence to support clinical interventions and teaching strategies. • Find established sources of evidence. • Implement and evaluate nationally sanctioned clinical practice guidelines. • Question and challenge nursing traditions. Copyright © 2018 Wolters Kluwer · All Rights Reserved Strategies for New Nurses to Promote Evidence-Based Practice—(cont.) • Dispel myths and traditions not supported by evidence. • Collaborate with other nurses locally and globally. • Interact with other disciplines to bring nursing evidence to the table. Copyright © 2018 Wolters Kluwer · All Rights Reserved Question Tell whether the following statement is true or false: New nurses should question and challenge nursing traditions. A. True B. False Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer A. True Rationale: New nurses should question and challenge nursing traditions and promote a spirit of risk taking in order to best utilize evidence-based practice. Copyright © 2018 Wolters Kluwer · All Rights Reserved Successful Decision Maker • Understands: – Gender – Personal individual values – Life experience – Preferences – Willingness to take risks – Brain hemisphere dominance – Predominant thinking style Copyright © 2018 Wolters Kluwer · All Rights Reserved Decision-Making Tools • Decision grids • Payoff tables • Decision trees • Consequence tables • Logic models • Program evaluation and review technique Copyright © 2018 Wolters Kluwer · All Rights Reserved Example of a Decision Tree Copyright © 2018 Wolters Kluwer · All Rights Reserved Economic Man versus Administrative Man Chapter 2 Copyright © 2018 Wolters Kluwer · All Rights Reserved Chapter 2 Classical Views of Leadership and Management Copyright © 2018 Wolters Kluwer · All Rights Reserved Leadership versus Management • Leaders – Empower others; maximize workforce effectiveness – Needed to implement the planned change that is part of system improvement • Managers – Guide, direct, and motivate others – Intervene when goals are threatened – Emphasize control Copyright © 2018 Wolters Kluwer · All Rights Reserved Managers and Leaders Leaders • Often do not have delegated authority but obtain their power through other means • Have a wider variety of roles than managers and may have different personal goals • Are frequently not part of the formal organization • Focus on group process, information gathering, feedback, and empowering others Managers • Are always assigned a position within an organization • Have a legitimate source of power due to the delegated authority that accompanies their position • Are expected to carry out specific functions • Emphasize control, decision making, decision analysis, and results Copyright © 2018 Wolters Kluwer · All Rights Reserved 1. A lack of energy and enthusiasm 2. Acceptance of their own mediocre performance 3. Lack of a clear vision and direction 4. Having poor judgment 5. Not collaborating 6. Not walking the talk 7. Resisting new ideas 8. Not learning from mistakes 9. A lack of interpersonal skills 10. Failing to develop others Ten Fatal Leadership Flaws Copyright © 2018 Wolters Kluwer · All Rights Reserved Characteristics of Managers • Have an assigned position within the formal organization • Have a legitimate source of power due to the delegated authority that accompanies their position • Are expected to carry out specific functions, duties, and responsibilities • Emphasize control, decision making, decision analysis, and results • Manipulate people, the environment, money, time, and other resources to achieve organizational goals • Have a greater formal responsibility and accountability for rationality and control than leaders • Direct willing and unwilling subordinates Copyright © 2018 Wolters Kluwer · All Rights Reserved Good Leaders and Managers Good Leaders • Envision the future • Communicate their visions • Motivate followers • Lead the way • Influence others to accomplish goals • Inspire confidence • Take risks • Empower followers • Master change Good Managers • Coordinate resources • Optimize resource use • Meet organizational goals and objectives • Follow rules • Plan, organize, control, and direct • Use reward and punishment effectively to achieve organizational goals Copyright © 2018 Wolters Kluwer · All Rights Reserved Question What aspect of business should managers emphasize? A. Decision making B. Analysis C. Results D. Control E. All of the above Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer E. All of the above Rationale: Control, decision making, analysis, and results are all crucial elements of successful management. Copyright © 2018 Wolters Kluwer · All Rights Reserved Question Which is a characteristic of a leader? A. Always assigned a position of authority B. Usually part of a formal organization C. Focus on group process, information gathering, and feedback D. Focus on decision making and results Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer C. Focus on group process, information gathering, and feedback Rationale: Although managers are more often part of a formal organization and focus more on resultoriented tasks, leaders tend to focus more on things such as group process. Copyright © 2018 Wolters Kluwer · All Rights Reserved Frederick W. Taylor (1911) Scientific Management • Four principles – Traditional “rule of thumb” – Scientific personnel system – Workers “fit” into the organization – Relationship between managers and workers is cooperative and interdependent. Copyright © 2018 Wolters Kluwer · All Rights Reserved Henri Fayol (1925) Management Functions • Planning • Organization • Command • Coordination • Control Copyright © 2018 Wolters Kluwer · All Rights Reserved The Management Process Copyright © 2018 Wolters Kluwer · All Rights Reserved Planning Encompasses determining philosophy, goals, objectives, policies, procedures, and rules; carrying out long- and short-range projections; determining a fiscal course of action; and managing planned change Copyright © 2018 Wolters Kluwer · All Rights Reserved Organizing • Includes establishing the structure to carry out plans, determining the most appropriate type of patient care delivery, and grouping activities to meet unit goals • Other functions involve working within the structure of the organization and understanding and using power and authority appropriately. Copyright © 2018 Wolters Kluwer · All Rights Reserved Staffing Consists of recruiting, interviewing, hiring, and orienting staff; scheduling, staff development, employee socialization, and team building are also often included as staffing functions Copyright © 2018 Wolters Kluwer · All Rights Reserved Directing Usually entails human resource management responsibilities, such as motivating, managing conflict, delegating, communicating, and facilitating collaboration Copyright © 2018 Wolters Kluwer · All Rights Reserved Controlling Includes performance appraisals, fiscal accountability, quality control, legal and ethical control, and professional and collegial control Copyright © 2018 Wolters Kluwer · All Rights Reserved Question Tell whether the statement is true or false: Team building is an aspect of staffing. A. True B. False Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer A. True Rationale: Although recruiting, interviewing, and hiring are the tasks most often associated with staffing, team building is also an important aspect of the job. Copyright © 2018 Wolters Kluwer · All Rights Reserved Luther Gulick (1937) Seven Activities of Management POSDCORB – Planning – Organizing – Staffing – Directing – Coordinating – Reporting – Budgeting Copyright © 2018 Wolters Kluwer · All Rights Reserved The Human Relations Era • Participatory management • Humanistic management • Emphasizes people rather than machines – Produced the “Hawthorne effect” Copyright © 2018 Wolters Kluwer · All Rights Reserved Leadership • Leadership is the art of getting work done through others willingly. • Leaders are in the front, moving forward, taking risks, and challenging the status quo. • A job title alone does not make a person a leader. Only a person’s behavior determines if he or she occupies a leadership position. Copyright © 2018 Wolters Kluwer · All Rights Reserved Leadership Roles • Decision maker • Communicator • Evaluator • Facilitator • Risk taker • Energizer • Mentor • Critical thinker • Buffer • Advocate • Coach • Counselor • Teacher • Forecaster • Visionary • Influencer • Creative problem solver • Change agent • Diplomat • Role model Copyright © 2018 Wolters Kluwer · All Rights Reserved The Evolution of Leadership Theories • Great Man theory/trait theories • Behavioral theories – Authoritarian leader – Democratic leader – Laissez-faire leader • Situational and contingency leadership theories • Interactional leadership theories • Transactional and transformational leadership • Full-range leadership theories Copyright © 2018 Wolters Kluwer · All Rights Reserved Kouzes and Posner’s Five Practices for Exemplary Leadership • Modeling the way: requires value clarification and selfawareness so that behavior is congruent with values • Inspiring a shared vision: entails visioning that inspires followers to want to participate in goal attainment • Challenging the process: identifying opportunities and taking action • Enabling others to act: fostering collaboration, trust, and the sharing of power • Encouraging the heart: recognize, appreciate, and celebrate followers and the achievement of shared goals Copyright © 2018 Wolters Kluwer · All Rights Reserved Transactional Leader • Focuses on management tasks • Is a caretaker • Uses trade-offs to meet goals • Does not identify shared values • Examines causes • Uses contingency reward Copyright © 2018 Wolters Kluwer · All Rights Reserved Question Tell whether the following statement is true or false: A characteristic of leadership management is to use trade-offs to meet goals. A. True B. False Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer A. True Rationale: Trade-offs can be a useful tool to achieve goals. Copyright © 2018 Wolters Kluwer · All Rights Reserved Transformational Leader • Identifies common values • Is committed • Inspires others with vision • Has long-term vision • Looks at effects • Empowers others Copyright © 2018 Wolters Kluwer · All Rights Reserved Integrated Leader/Managers (Gardner, 1990) • Think longer term • Look outward, toward the larger organization • Influence others beyond their own group • Emphasize vision, values, and motivation • Are politically astute • Think in terms of change and renewal Chapter 3 Copyright © 2018 Wolters Kluwer · All Rights Reserved Chapter 3 Twenty-First Century Thinking About Leadership and Management Copyright © 2018 Wolters Kluwer · All Rights Reserved • Please show Leadership Video Case: Leadership Succession and Creating a Motivating Climate, available as part of Lippincott CoursePoint for Marquis and Huston: Leadership Roles and Management Functions in Nursing, 9th edition. • For more info, visit thePoint.lww.com/CPMarquis9e. Copyright © 2018 Wolters Kluwer · All Rights Reserved Factors Affecting Health-Care Trends • Growing elderly population • Healthcare reform • Reductions in reimbursements • New quality imperatives • Shift in focus of care to community settings • Technological advances • Shift to customer-focused care Copyright © 2018 Wolters Kluwer · All Rights Reserved Qualities of a Nurse-Manager • Knowledgeable and skilled in nursing practices • Competent in all aspects of management • Excellent communicator • Effective team builder • Proactive in preparing for emerging new threats Copyright © 2018 Wolters Kluwer · All Rights Reserved Focus of Recent Leadership and Management Concepts • Organizational context • Levels of analysis • Potential boundary conditions on transformational leadership • Interactional leadership Copyright © 2018 Wolters Kluwer · All Rights Reserved Leader-Manager’s Repertoire for the 21st Century • Strength-based leadership • Level 5 leadership • Servant leadership • Principal agent leadership • Human and social capital theory • Emotional intelligence and authentic leadership • Quantum and thought leadership Copyright © 2018 Wolters Kluwer · All Rights Reserved Strength-Based Leadership • Focuses on the development or empowerment of worker’s strengths • Activities include: – Paying attention to multiple points of view – Searching for common ground – Prioritizing continuous learning in the workplace – Promoting collaborative relationships (Wong) Copyright © 2018 Wolters Kluwer · All Rights Reserved Strength-Based Nursing Leadership • Works with the whole while appreciating the interrelationships among its parts • Recognizes the uniqueness of staff, nurse-leaders, and the organization • Creates work environments that promote nurses’ health and facilitate their development • Understands the significance of subjective reality and created meaning • Values selfdetermination • Recognizes that person and environment are integral and that nurses function best in environments where there is a “goodness of fit" that capitalizes on their strengths Copyright © 2018 Wolters Kluwer · All Rights Reserved Strength-Based Nursing Leadership—(cont.) • Creates environments that promote learning and recognizes the importance of readiness and timing • Invests in collaborative partnerships Copyright © 2018 Wolters Kluwer · All Rights Reserved Jim Collins’s Level 5 Leadership Copyright © 2018 Wolters Kluwer · All Rights Reserved Jim Collins’s Level 5 Leadership— (cont.) Copyright © 2018 Wolters Kluwer · All Rights Reserved Focus of Greenleaf’s Servant Leadership • Putting others including employees, customers, and the community as the number one priority • Fostering a service inclination in others that promotes collaboration, teamwork, and collective activism Copyright © 2018 Wolters Kluwer · All Rights Reserved Principal Agent Theory • Suggests that not all followers (agents) are inherently motivated to act in the best interest of the leader or employer (principal) • Followers may have an informational (expertise or knowledge) advantage over the leader as well as their own preferences, which may deviate from the principal’s preferences. • Principals must identify and provide agents with appropriate incentives to act in the organization’s best interest. Copyright © 2018 Wolters Kluwer · All Rights Reserved Human and Social Capital Theory • Human capital represents the capability of the individual. • Social capital represents what a group can accomplish together. Copyright © 2018 Wolters Kluwer · All Rights Reserved Emotional Intelligence • Emotional intelligence refers to the ability to use emotions effectively and is required by leaders/managers in order to enhance their success. • Emotional intelligence is critical for building a cooperative and effective team. Copyright © 2018 Wolters Kluwer · All Rights Reserved Five Components of Emotional Intelligence • Self-awareness • Self-regulation • Motivation • Empathy • Social skills Source: Goleman (1998) Copyright © 2018 Wolters Kluwer · All Rights Reserved Which of the following is a component of emotional intelligence? A. Self-reliance B. Assertiveness C. Self-regulation D. Charisma Question Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer C. Self-regulation Rationale: The five components of emotional intelligence are self-awareness, self-regulation, motivation, empathy, and social skills. Self-reliance, assertiveness, and charisma are not components of emotional intelligence. Copyright © 2018 Wolters Kluwer · All Rights Reserved Authentic Leadership • Suggests that in order to lead, leaders must be true to themselves and their values and act accordingly • Avolio et al. (2009) suggest that there are four factors that cover the components of authentic leadership: balanced processing, internalized moral perspective, relational transparency, and selfawareness. Copyright © 2018 Wolters Kluwer · All Rights Reserved Five Distinguishing Characteristics of the Authentic Leader Copyright © 2018 Wolters Kluwer · All Rights Reserved Five Distinguishing Characteristics of the Authentic Leader—(cont.) Copyright © 2018 Wolters Kluwer · All Rights Reserved Thought Leadership • Thought leadership applies to a person who is recognized among peers for innovative ideas and who demonstrates the confidence to promote these ideas. • Thought leaders attract followers not by any promise of representation or empowerment but by their risk taking and vision in terms of being innovative. • Ideas put forth by thought leaders are future-oriented and generally problem-oriented. Copyright © 2018 Wolters Kluwer · All Rights Reserved Question Tell whether the following statement is true or false: Thought leaders attract followers by the promise of representation or empowerment. A. True B. False Copyright © 2018 Wolters Kluwer · All Rights Reserved Answer B. False Rationale: Thought leaders attract followers by their risk taking and vision in terms of being innovative. Copyright © 2018 Wolters Kluwer · All Rights Reserved Reflective Thinking and Practice • Nurse-managers need to continually adapt, reflect on progress and setbacks, and adjust their course. • Consider what one knows • Believe and value current situation • Reframe to develop future responses and actions Copyright © 2018 Wolters Kluwer · All Rights Reserved • States that leaders must work together with subordinates to identify common goals, exploit opportunities, and empower staff to make decisions for organizational productivity to occur • Suggests that the environment and context in which people work is complex and dynamic and that this has a direct impact on organizational productivity Quantum Leadership Copyright © 2018 Wolters Kluwer · All Rights Reserved Comparing Industrial and Relationship Age Leadership
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